There's a short New York Times article from Tuesday on becoming a co-conspirator when confronted by a delusion. This approach isn't viewed with favor by everyone in the dementia care community but it's worth considering. You can find the article here:

Article on Avoiding Arguments with Alzheimer's PatientsâYou canât win an argument with Alzheimerâs patients but you can redirect them.â Adapted from Caregiver Newsletter of the Duke Family Support Program, East Central Illinois Chapter

âHe tells me he wants to go home. Weâve lived here for 35 years, and when I try to explain to him, he gets mad at me.â âIâve told her time and time again not to put things in the wastebasket, but she doesnât listen.â âMy Dad asks, âWhy donât the buses run by here anymore?â and âHow far is it to the river?â When I tell him itâs 3,000 miles to the river, he gets mad and says I am a fool. He thinks heâs in Cleveland. He hasnât been there in 50 years.â

We have a hard time letting go of the old habit of reasoning with our spouse, parent or friend who has been moved beyond reason by dementing illness. It is important to keep in mind that real deterioration of brain tissue is the cause of apparently irrational behavior. Persons with the disease are not behaving this way to annoy or irritate. In fact, they are probably unable to consider the impact of their actions on others.

Seldom will it work to âteachâ someone with Alzheimerâs disease not to hide things in the wastebasket. Instead, we can teach the caregiver to accept this behavior as harmless and to check the wastebaskets before emptying them.

The woman whose husband wanted to go home learned she succeeded only in frustrating both of them when she tried to âexplainâ that they were at home. Rather, what worked was to go outside and walk to the corner and back. Upon entering the house a few minutes later, her husband was content. His short-term memory was poor and he would ask the same question again later, but there is an important lesson here: There is no reason why the patientâs reality must conform to ours. If Dad thinks heâs in Cleveland, what is the harm in that?

If an Alzheimerâs patient expresses a request that is obviously impossible, we may be tempted to respond with a reasonable explanation of why it canât be done. A caregiver tells of the time her husband woke at one in the morning and wanted to go to San Francisco. Rather than explaining to him all the reasons why it wasnât a good idea, she said, âAll right, but weâll have to get dressed first.â And ten minutes into this process she suggested having some ice cream and then watching television, and then going to bed. His poor short-term memory allowed her to redirect him. No one underestimates the stress of being awakened at 1 A.M. and kept up for 40 minutes, but it could have been worse if the patient had become agitated in an argument about the appropriateness of a visit to the city.

Sometimes it helps to become a co-conspirator. Perhaps you have hidden the keys to the car and Dad wants them, or youâve come to visit Mom and she accuses you of taking the checkbook she mislaid. Instead of responding to the real situation (why Dad canât drive or Momâs history of losing things and the hurt of accusations), we might agree that the items are lost and offer to help look for them. After looking for a bit, try suggesting, âWell, weâll find them, but letâs sort clothes right now. We really need to get this done.â

Wait for an opportunity to redirect and always talk positively about the future. âItâs going to be all right.â Remember, you can never win an argument with an Alzheimerâs patient.

Source: adapted from Caregiver Newsletter of the Duke Family Support Program, East Central Illinois Chapter, as seen on the National Capital Area Chapter of the Alzheimerâs Association website (www.alz-nca.org).

Thu Mar 31, 2011 11:19 am

Ger

Joined: Mon Feb 21, 2011 9:55 pmPosts: 355

Re: Become a co-conspirator in delusions (2 articles)

Excellent advice, I think, Robin. I have to say I follow this rule all the time.

_________________cared for Dad who passed away on January 28th 2013 R.I.P.

Thu Mar 31, 2011 11:55 am

JeanneG

Joined: Fri Dec 31, 2010 3:07 pmPosts: 1039Location: Minnesota

Re: Become a co-conspirator in delusions (2 articles)

Thanks, Robin. This is certainly a good concept to know about and use when it fits. We can't explain away an irrational idea and there is no point in arguing with a demented person. That only adds distress for both of you.

I like the specific example of the middle-of-the-night travel request. This isn't an instant solution -- sometimes it takes time and effort to redirect.

But I can't figure out how you would apply this to a spouse with a delusion that you are unfaithful. "It hurts when someone doesn't live up to their promises, doesn't it? Here, let's go have some ice cream."

And it gets more complicated with someone whose short term memory isn't faulty enough that redirection works. "OK, now we've had a snack and we've driven around the block, but when are you going to drive me to the airport so I won't be late for the Governor's Conference? I'm the keynote speaker, you know." In answer the the question, "If Dad thinks heâs in Cleveland, what is the harm in that?" -- probably no harm in general and in most situations. No harm in Dad's thinking he is Governor of North Dakota. But if Dad's short term memory is still working and his delusion is long-running and he is not easily redirected, there will be surely a lot of repeat performances with challenges to avoid agitation!

Still, exceptions don't mean it is not a good idea in many situations, and worth a thorough try.

Thanks for sharing.

_________________Jeanne, 68 cared for husband Coy, 86. RBD for 30+ years; LDB since 2003, Coy at home, in early stage, until death in 2012

Thu Mar 31, 2011 2:13 pm

Leone

Joined: Wed Oct 28, 2009 11:53 amPosts: 969Location: Ocala, FL

Re: Become a co-conspirator in delusions (2 articles)

JeanneG wrote:

but when are you going to drive me to the airport so I won't be late for the Governor's Conference? I'm the keynote speaker, you know."

You reminded me, Jeanne, of the time Dale thought he was the new coach of the Denver Broncos. He insisted that I buy him a 'cod-piece' which is still in his drawer! The delusion lasted at least a week and he was packing a suitcase and demanding that I take him to the airport when I finally was able to say something that brought him back to reality. It was a terrible week.

You who live with these delusions day by day are surely earning stars in your crown!

Leone, at least the piece of equipment you needed to buy in the co-conspiracy was relatively inexpensive.

_________________Jeanne, 68 cared for husband Coy, 86. RBD for 30+ years; LDB since 2003, Coy at home, in early stage, until death in 2012

Thu Mar 31, 2011 2:29 pm

mockturtle

Joined: Wed Dec 30, 2009 1:46 pmPosts: 3213Location: WA

Re: Become a co-conspirator in delusions (2 articles)

One evening when Derek insisted on going 'home', I put him in the car, drove around for about fifteen minutes, drove home and said, 'Well, here we are!'. It didn't fool him, he was furious that I had 'tricked' him, went ballistic and I had to call the police. When he is hell-bent on a delusional fixation he can't be redirected or fooled. It's easier, with him, just to keep saying, 'I know, honey! I wish we could both go home!'. But it certainly is true that you can't argue with them. Not successfully, anyway!

The unfaithfulness issue is hard. It hasn't been a major part of our Lewy experience but rears its head from time to time. All I can think of to say is: 'It makes me feel sad that, after all these years, you think that about me. You know I love only you!' The other day, when in his room at the SNF, I had a cell phone call from my younger daughter and, as I hung up, I said, 'Love you!', as I always do. Derek asked me, 'How many boyfriends do you have?' I said, 'What makes you think I have boyfriends?' 'You said you love him'. 'That was Molli on the phone. She's my daughter and I do love her'. At least he seemed to believe me.

_________________Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.

Thu Mar 31, 2011 2:55 pm

dorthea

Joined: Sat Oct 06, 2007 4:28 pmPosts: 781Location: LA

Re: Become a co-conspirator in delusions (2 articles)

My most successful venture with stopping a delusion came when Mr Bobby was puzzled about a second wife that had been haunting our home. He confided in me that he could not remember of getting married but one time so how could he have two wives and where is she now? I answered that I had chased her out of the house with an iron skillet and if she returned I would do the same thing all over agan. He loved it.

Dorthea

_________________"See this lady she's 85 but she's nice", This is the way my husband, Mr B., introduced me in 2006 to the people only he knew. Death due to pneumonia. Lewy Body Dementia diagnosed post mortem at Mayo Clinic in Jacksonville Florida.

Thu Mar 31, 2011 4:14 pm

Ger

Joined: Mon Feb 21, 2011 9:55 pmPosts: 355

Re: Become a co-conspirator in delusions (2 articles)

well done Dorthea

_________________cared for Dad who passed away on January 28th 2013 R.I.P.

Thu Mar 31, 2011 4:54 pm

mistyeye

Joined: Mon Jun 21, 2010 2:24 pmPosts: 32

Re: Become a co-conspirator in delusions (2 articles)

I have had success with much the same situation, except my husband thinks there are 3 of me. So when something goes 'bad', I just tell him 'it must have been one of the other two, because I dont know anything about it.' Sometimes it works, sometimes it doesnt, but he does seem to think that one of them has all of his credentials, so she could get him in some kind of trouble. This might be nice if he ever had to go back to the facility for getting his meds adjusted, which I think is coming soon. Maybe I can blame it on 'her'. That may get me out of the dog house!!!

Thu Mar 31, 2011 5:20 pm

LTCVT

Joined: Fri Jan 15, 2010 9:33 pmPosts: 3441Location: Vermont

Re: Become a co-conspirator in delusions (2 articles)

My dad wanted me to take him "home" after he moved to the ALF, and home was both his house he'd lived in for 58 years and the town where he grew up, about 20 mi. from his house. When he first moved, I didn't want to take him to either place because I thought he'd be really sad and depressed, plus I couldn't get him out of or back into the car anyway, and it would have been minimally a 2 hr drive roundtrip. As he became more and more disabled and more delusional, this was the one short term memory that didn't seem to get lost or be redirected. He'd say "you told me last time you were here you'd take me home and you still haven't done it. When are we going?" Finally one day I said "as soon as you can get yourself out of bed by yourself and walk again with your walker we'll go. So, you need to practice." That was the only response that ever got him to stop asking about going home. One day last summer he heard me tell someone I was going to Dover, Del. to a peach farm to get some peaches and he looked at me so excited and said "I'd like to go with you!" I felt so awful because I knew he could never have made the trip, which the driving alone would have been about 3 hr. without even stopping. It was a little thing he and I did every summer together for years, and I just couldn't even go by myself after that because it made me feel so sad that he couldn't go with me. Redirecting often works, but there are sometimes it just doesn't...... Lynn

_________________Lynn, daughter of 89 year old dad dx with possiblity of LBD, CBD, PSP, FTD, ALS, Vascular Dementia, AD, etc., died Nov. 30, 2010 after living in ALF for 18 months.

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